{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T06:15:56Z","timestamp":1791180956254,"version":"4.1.0"},"reference-count":24,"publisher":"Cambridge University Press (CUP)","issue":"8","license":[{"start":{"date-parts":[[2015,1,2]],"date-time":"2015-01-02T00:00:00Z","timestamp":1420156800000},"content-version":"unspecified","delay-in-days":4172,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2003,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0195941700081790_abs1\"><jats:title>Objective:<\/jats:title><jats:p>To assess the safety and efficacy of a chlorine dioxide water treatment system in controlling <jats:italic>Legionella<\/jats:italic> in a hospital water supply.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700081790_abs2\"><jats:title>Design:<\/jats:title><jats:p>For 17 months following installation of the system, we performed regular water cultures throughout the building, assessed chlorine dioxide and chlorite levels, and monitored metal corrosion.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700081790_abs3\"><jats:title>Results:<\/jats:title><jats:p>Sites that grew <jats:italic>Legionella<\/jats:italic> species decreased from 41% at baseline to 4% (<jats:italic>P<\/jats:italic> = .001). <jats:italic>L. anisa<\/jats:italic> was the only species recovered and it was found in samples of both hot and cold water. Levels of chlorine dioxide and chlorite were below Environmental Protection Agency (EPA) limits for these chemicals in potable water. Further, enhanced carbon filtration effectively removed the chemicals, even at chlorine dioxide levels of more than twice what was used to treat the water. After 9 months, corrosion of copper test strips exposed to the chlorine dioxide was not higher than that of control strips. During the evaluation period, there were no cases of nosocomial <jats:italic>Legionella<\/jats:italic> in the building with the system, whereas there was one case in another building.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700081790_abs4\"><jats:title>Conclusions:<\/jats:title><jats:p>Our results indicate that operation of a chlorine dioxide system effectively removed <jats:italic>Legionella<\/jats:italic> species from a hospital water supply. Furthermore, we found that the system was safe, as levels of chlorine dioxide and chlorite were below EPA limits. The system did not appear to cause increased corrosion of copper pipes. Our results indicate that chlorine dioxide may hold promise as a solution to the problem of <jats:italic>Legionella<\/jats:italic> contamination of hospital water supplies.<\/jats:p><\/jats:sec>","DOI":"10.1086\/502254","type":"journal-article","created":{"date-parts":[[2006,3,14]],"date-time":"2006-03-14T21:59:36Z","timestamp":1142373576000},"page":"575-579","source":"Crossref","is-referenced-by-count":59,"title":["A 17-Month Evaluation of a Chlorine Dioxide Water Treatment System to Control <i>Legionella<\/i> Species in a Hospital Water Supply"],"prefix":"10.1017","volume":"24","author":[{"given":"Arjun","family":"Srinivasan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Bova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracy","family":"Ross","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Mackie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Paquette","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Merz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trish M.","family":"Perl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2015,1,2]]},"reference":[{"key":"S0195941700081790_ref001","volume-title":"Hospital Epidemiology and Infection Control","author":"Stout","year":"1999"},{"key":"S0195941700081790_ref002","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(85)90349-6"},{"key":"S0195941700081790_ref008","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1002\/j.1551-8833.1998.tb08503.x","article-title":"Legionella in water distribution systems","volume":"90","author":"Lin","year":"1998","journal-title":"Journal of the American Water Works Association"},{"key":"S0195941700081790_ref006","first-page":"257","article-title":"Legionnaire's disease: new insights","volume":"12","author":"Yu","year":"1991","journal-title":"Clin Chest Med"},{"key":"S0195941700081790_ref021","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.792949"},{"key":"S0195941700081790_ref007","doi-asserted-by":"publisher","DOI":"10.2307\/30142013"},{"key":"S0195941700081790_ref020","first-page":"465","article-title":"Groups at potentially high risk from chlorine dioxide treated water","volume":"4","author":"Moore","year":"1980","journal-title":"J Environ Pathol Toxicol"},{"key":"S0195941700081790_ref013","doi-asserted-by":"publisher","DOI":"10.1016\/S0890-6238(00)00086-1"},{"key":"S0195941700081790_ref009","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199709043371006"},{"key":"S0195941700081790_ref015","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.96104516"},{"key":"S0195941700081790_ref016","doi-asserted-by":"publisher","DOI":"10.1016\/S0195-6701(96)90058-4"},{"key":"S0195941700081790_ref005","volume-title":"Second Report of the Committee of Inquiry Into the Outbreak of Legionnaire's Disease in Stafford in April 1985, London, England","year":"1987"},{"key":"S0195941700081790_ref012","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.pu.03.050182.002141"},{"key":"S0195941700081790_ref010","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268800057745"},{"key":"S0195941700081790_ref014","doi-asserted-by":"publisher","DOI":"10.1016\/0048-9697(91)90309-3"},{"key":"S0195941700081790_ref018","volume-title":"Standard Methods for the Examination of Water and Wastewater"},{"key":"S0195941700081790_ref003","doi-asserted-by":"publisher","DOI":"10.2307\/30142014"},{"key":"S0195941700081790_ref022","doi-asserted-by":"publisher","DOI":"10.1080\/00039896.1987.9935821"},{"key":"S0195941700081790_ref019","first-page":"14502","article-title":"National primary drinking water regulations","volume":"67","year":"2002","journal-title":"Federal Register"},{"key":"S0195941700081790_ref024","doi-asserted-by":"publisher","DOI":"10.1086\/313512"},{"key":"S0195941700081790_ref017","unstructured":"Hood J , Cheape G , Mead A , Curran E . Six years' experience with chlorine dioxide in the control of Legionella pneumophila in the potable water supply of Glasgow Royal Infirmary. Presented at 4th Decennial Conference on Nosocomial and Healthcare Associated Infections; March 7, 2000; Atlanta, GA"},{"key":"S0195941700081790_ref023","doi-asserted-by":"publisher","DOI":"10.1016\/0273-2300(90)90006-W"},{"key":"S0195941700081790_ref004","doi-asserted-by":"publisher","DOI":"10.2307\/30142015"},{"key":"S0195941700081790_ref011","first-page":"14502","article-title":"National primary drinking water regulations","volume":"67","year":"2002","journal-title":"Federal Register"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0195941700081790","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,5,6]],"date-time":"2019-05-06T22:49:36Z","timestamp":1557182976000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0195941700081790\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2003,8]]},"references-count":24,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2003,8]]}},"alternative-id":["S0195941700081790"],"URL":"https:\/\/doi.org\/10.1086\/502254","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2003,8]]}}}